Services & Solutions for Healthcare Payers

What We Do

Simplifying. Streamlining. Dealing with the details.

We offer healthcare payer and health plan services that help reduce costs, streamline processes, and improve member and provider communication. By combining data and membership management services, turn key Business Process Outsourcing, and the tools to keep your daily operations simple, easy to handle, and ahead of the curve, we can help your business push forward without being bogged down in data and details.

Provider Data Management

Many health plans rely on legacy systems where provider data is stored in multiple, disconnected data repositories. Core xRM’s Provider Data Manager (PDM) offers a health plan the option to manage all provider data in a consolidated source of truth thereby eliminating the need to cross-reference multiple systems for operational functions such as contracting, online provider directories, and reimbursement.

Provider Data Quality BPO Service

Inaccurate provider data has plagued the healthcare industry for decades. The provider data problem is universal, and the effects are felt by health plans, TPAs, integrated delivery systems, population health organizations, consumers, and providers. In response to consumer complaints, federal and state agencies have introduced penalties for health plans that don’t comply with recently formed regulatory requirements.

Membership Management

The Core xRM Membership Management Solution (MMS) offers the health plan the opportunity to create a consolidated membership source of truth to facilitate various operational and reporting functions. Data from enrollment, eligibility, payment, and claims systems can be combined to paint a 360 degree view of the member.

Software & Tools

We offer a full suite of software to help you automate processes, increase administrative efficiencies, handle multiple lines of business across markets, and support connectivity between members, providers, and trading partners.

IT Services

We offer a comprehensive portfolio of IT and system integration services including:

Project Management

Program Management

Systems Integration

Requirements

Testing

White Paper

Achieving Provider Data Quality in Your Directory

Members utilize online provider directories to select participating providers, however data inaccuracies inherent in provider data has led to increased consumer frustration. As a result, state and federal regulators have recently updated their guidance and introduced penalties for non-compliant directories, thereby forcing health plans to rethink how they manage provider data.

Core xRM offers provider data verification as a BPO service to health plans and payers.

Case Studies

We’re proud that we aren’t the only ones who love the work we do. If you want to hear straight from clients that we’ve had the privilege to work with, these case studies will give you a unique insight into our business, our process, and how we can help you succeed.

To improve the accuracy of provider information, Core xRM leveraged their Provider Data Quality (PDQ) BPO service. The PDQ service utilizes a suite of proprietary technologies operated by Core xRM’s provider data trained call center staff to work with providers offices to efficiently verify the accuracy of critical information for each provider and service location in the network.